HST.161 Molecular Biology and Genetics in Modern Medicine · Selection: Genetic Lethal Can Eliminate One Genetic Class at Some Point in Life AA Aa aa At conception p 2pq q 2 2 Early

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HST.161 Molecular Biology and Genetics in Modern Medicine Fall 2007

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THALASSEMIAS• PATHOLOGY IN THALASSEMIA IS A

CONSEQUENCE OF AN IMBALANCE IN ALPHAAND BETA GLOBIN CHAIN SYNTHESIS

• EXCESS ALPHA OR BETA CHAINS AREINSOLUBLE IN THE RBC

• PRECIPITATED GLOBIN GENES DAMAGE THERED CELL MEMBRANE SHORTENING RED CELLHALF LIFE

• ANEMIA CAN BE CORRECTED BY TRANSFUSION

• CONTINUOUS TRANSFUSION CAN LEAD TOIRON OVERLOAD

Harvard-MIT Division of Health Sciences and TechnologyHST.161: Molecular Biology and Genetics in Modern Medicine, Fall 2007Course Directors: Prof. Anne Giersch, Prof. David Housman

Hemoglobinopathies and

Thalassemias• Mutations which alter the function of either

the alpha or beta globin genes

• Hemoglobinopathies--mutations which causea change in primary structure of one of theglobin chains--over 700 known

• Thalassemias--mutations which alter the levelof expression of one of the globin chains--over 280 known

Mutations in ! thalassemia

Image removed due to copyright restrictions. Genetic map of mutations that cause beta-thalassemia.

! thalassemia alleleshave been beendescribed for almostevery process affectinggene expression

" and ! chromosomal loci

Image removed due to copyright restrictions.

Developmental expression pattern proceeds alongEach locus: #$%$! and &$"

Strong expression requires upstream regulatory elements

Images removed due to copyright restrictions. Illustrations of alpha-globin gene cluster on chromosome 16, and beta-globin gene cluster on chromosome 11.

Thalassemia Genotypes and

Syndromes

Alpha Thalassemia α genes Globin Chains Hemoglobin Anemia

Beta Thalassemia β genes Globin Chains Hemoglobin Anemia

Normal

Normal

Silent Carrier

Trait

Hb H disease

Hydrops fetalis

Thalassemia minor

Thalassemia major

αα/αα

αα/α-

α-/α---/αα--/-α

--/--

β/β

β+/ββο/β

β+/β+βο/βο

γ/γ

α2β2

α2β2

α2β2, α2δ2, α2γ2

α2β2, α2δ2, α2γ2, α2γ2, α2δ2

α2β2

α2β2

α2β2, β4

γ4,ζ2γ2

α2γ2

A

A

A

A, A2, F

A, A2, F F, A2

A

A, H

BartsPortland

F

None

None

None

Mild

Mild

Mild

Intermediate

Lethal

SevereSevere

HPFH*

Figure by MIT OpenCourseWare.

Splice variants are one of the most frequent causes o! thalassemia alleles: A Mutation Can Create A New Splic

Site in an Intron

fe


LOSS OF A

NORMAL

SPLICE SITE

DUE TO A

SINGLE BASE

CHAGE

Image removed due to copyright restrictions. Common Genetic sequence of common Mediterranean mutation for beta thalassemia.

Meditarranean

Mutation for !

Thalassemia

IVS-1, position 1

(G ! A)

MUTATION OF G TO A DESTROYS THE NORMAL SPLICE SIGNAL ADJACENT TO

CODON 30; AN ABNORMAL mRNA IS PRODUCED WHICH INCLUDES SEQUENCES

FROM INTRON 1; INCORRECT AMINO ACIDS ARE ADDED AFTER POSITION 30

AND A SHORT POLYPEPTIDE IS PRODUCED FOLLOWING A TERMINATION

CODON WHICH OCCURS IN THE INTRON 1 SEQUENCE

Hemoglobin E: A Mutation in an Exon Creates a New Splice Site

Causing 40% of mRNA made to be Non-functional; the remaining RNA encodes a ! Globin with a single amino acid

change--glutamic acid (GAG) to lysine (AAG) at position 26


HbE has a very high allele frequency and

widespread distribution in southeast Asia

Mutations in the Promoter, the 3’ UTR or the poly A

Site Can Reduce mRNA Expression Levels


The TATA box is an important sequence for most eukaryotic

promoters because it binds the key transcription factor TBP


! Thalassemia mutations in the TATA box include:

-31 A to G

-30 T to A and -30 T to C

-29 A to G

-28 A to G

An important CCCCC element is located upstream of

the start of transcription between positions -86 and -90

of the ! globin gene

! Thalassemia mutations in this element include:

-90 C to T

-88 C to A or T

-87 C to A or G or T

-86 C to G

Mutations affecting mRNA

polyadenylation at the polyAsite can cause ! thalassemia

• AATAAA is the ! globin poly A site• Mutations seen in ! thalassemia

• AACAAA

• AATTAA

• AATTGA Image removed due to copyright restrictions.

• AATAAC

Capping the 5!End.

Caps at the 5"end of

eukaryotic mRNA include

7-methylguanylate (red)

attached by aImage removed due to copyright restrictions.

triphosphate linkage to

the ribose at the 5"end.

Mutation in silent ! thalssemia +1 A to C prevents cap formation

A Mutation in the Chain termination Codon Causes a Longer " Globin

to be Produced; the Mutation also Causes Instability of the mRNA

Leading to Reduced levels of Gene Expression

Image removed due to copyright restrictions. Chart showing that reduced mRNA levels correlate with reduced globin expression.

DNA sequences such as ! LCR and " HS40 play a

Key Role in Controlling Expression of Each Locus


DELETION OF THE HS40 BOX LEADS TO

INACTIVATION OF TRANSCRIPTION OF THE " GENE


Gene Sequences at a

Distance from the Gamma

Globin Chain Gene Affect

Level of Expression

• Deletions of beta chain gene can

lead to increased levels of gamma

chain synthesis


Deletions which entirely eliminate

the Beta Globin Gene Cause the

Gamma Chain Genes to Remain

On-- Hereditary Persistence of

Fetal Hemoglobin (HPFH)

Worldwide Distribution of Globin Disorders

Epidemiology and the malaria

hypothesis

Distribution of thalassemias, sickle

cell disease, G6PD mirror worldwide

distribution of malaria prior to 20th

century.

Hypothesis (Haldane and others):

heterozygous forms confer fitness -

Thal trait, sickle trait, G6PD

protective against death from

cerebral falciparum malaria

Images removed due to copyright restrictions. Maps showing the similar worldwide distributions of falciparum malaria and alpha-thalassemia.

Malaria

AA

Thalassemia

aa

AA

Aa

Balanced Polymorphism

Hardy-Weinberg Equilibrium

• large population [A] = p

[a] = q• no mutation

p + q =1• no selection

• random mating [AA] = p2

[Aa] = 2pq• no migration [aa] = q2

frequencies remain stable

AA Aa

aA aa

p pq

pq q2

2

sperm

eggs

A

a

A a

p

p

q

q

=

==

=

allele frequency

allele

frequency

The only reason that Hardy-Weinberg should not hold at

conception is assortative mating

Selection: Genetic Lethal

Can Eliminate One Genetic

Class at Some Point in Life

AA Aa aa

At p2

2pq q2

conceptionAfter lethal p

22pq 0

events

Selection: Genetic Lethal Can Eliminate One

Genetic Class at Some Point in Life AA Aa aa

At conception 2 2

p 2pq q

Early in life—2

p 2pq Less

some lethal 2

than q

events reduce aa class Later in life—

2p 2pq Much

more lethal less

events 2

than q

reduce aa class After all lethal

2p 2pq Can be as

low as 0 events

Balanced Selection: Genetic Lethal Can

Eliminate More than One Genetic Class

AA Aa aa

At conception p2 2 p q 2

q

Early in life—some Less than 2 p q Less than

lethal events p2 2 q

reduce AA and aa

classes

Later in life—more Much 2 p q Much less

lethal events less than than q2

reduce AA and aa p2

classes

After all lethal events Can be 2 p q Can be as

as low low as 0

as 0

Age Related Allele Frequencies can

Demonstrate Genetic Selection

Operating on a Population

• Deviations from HWE as a function of age can

demonstrate survival effects of alternative alleles at a

locus

Genetic Selection Operating on a

Population will Influence Allele

Frequencies in Subsequent

Generations

• Reproductive fitness of each genotype class at the time of

mating is the critical parameter in determining the

genotype composition of the next generation

AA aaAa 0.5 0.51

0.66 0.332

0.75 0.253 AA

AA

Aa

Aa aa

aa

gene pool

gene pool

What matters for the next generation is the proportion of

individuals in each genotype class at the time of mating and their

relative effectiveness in mating--REPRODUCTIVE FITNESS

generation p q

Fitness

fitness: proportion of offspring compared with “normal”

coefficient of selection = 1-F

F = 1, s = 0 if normal number of offspring

F = 0, s = 1 if lethal

Change in Allele Frequency Because

of Reduced Reproductive FitnessAA Aa aa

At birth p2

2pq q2

Fitness 1 1 1-s

In Next Generation p2

2pq q2(1-s)

AA aaAa

p q

0.5 0.51

0.66 0.332

0.75 0.253 AA

AA

Aa

Aa aa

aa

generation

gene pool

gene pool

Even though selection may remove all homozygous recessives

from the reproductive pool, heterozygote matings recreate this

genotype class in the next generation

Change in Gene Frequency

with Extremely Reduced Reproductive Fitness of the

Homozygous Recessive

Even after many generations the recessive allele remains at a

significant frequency in the population but over time it gradually

will drop to lower and lower population frequencies UNLESS

Heterozygote Advantage

When allele frequencies for the recessive allele remain high even after manygenerations despite negative selection of the recessive homozyogote, thenselection in favor of the heterozygote should be considered

Examples: sickle cell anemia, thalassemia, cystic fibrosis, hereditaryhemochromatosis, ccr5 deletion

Epidemiology and the malaria

hypothesis

Homozygote loss of fitness balanced

by increased fitness of heterozygote

>200 million people are heterozygous

carriers of thal mutations

~1 million with HbE/!0 thalassemia

tens of thousands with homozygous

thal syndromes. syndromes.

Images removed due to copyright restrictions. Maps showing the similar worldwide distributions of falciparum malaria and alpha-thalassemia.

Image removed due to copyright restrictions. Graph showing the leading infectious killers in 1998, worldwide: acute respiratory diseases (3.5 million), AIDS (2.3 million), diarrheal diseases (2.2 million), malaria (1.1 million), and measles (0.9 million).

Malaria--Worldwide Impact

• 40% of the world's population - mostly those livingin the poorest countries - is at risk of malaria.

• Malaria causes between 300 - 500 million cases ofacute illness and over 1 million deaths annually.

• 90% of deaths due to malaria occur in Africa, southof the Sahara desert - mostly amongst young children.

• Malaria is the number one killer of young children inAfrica, accounting for 1 in 5 of all childhood deaths

Species of Plasmodium which

cause Malaria • P. falciparum is the major killer among

the four species of plasmodium whichinfect humans

• P. vivax, p. malariae and p.ovale causeserious illness but are not responsiblefor the high death rate caused bymalaria in humans

Plasmodium falciparum has a very

broad world wide distribution. It has

a tertain pattern of fevers. It is

responsible for most malaria

fatalities. Infected red blood cells

develop surface 'knobs' which

cause them to stick to endothelial

cells (cells lining blood vessels). Image removed due to copyright restrictions. Life stages of P. falciparum. This causes blockages and brain

and intestinal damage, often

resulting in death, which can occur

within a few days of infection. P.

falciparum is

especially dangerous to small

children and to travellers from non-

malarious areas. There is no

dormant hyponozoite stage.

What about immunity?

• Adults from areas where malaria is endemic develop aform of partial immunity.

• This partial immunity develops slowly and only in responseto repeated infections.

• In partially immune people, malaria parasites can often befound in the blood, but without clinical symptoms.

• Immunity is lost if exposure is not maintained. (after 6months).

Malaria

• P. falciparum can cause repeated inefections;immune response is very limited

• P. falciparum causes infected red blood cells toexhibit protruding knobs which stick to endothelialcells lining blood vessels

• Blockage of blood vessels in the brain causescerebral malaria--a major cause of death

• Blockage of intestinal blood vessels also important inpathology

Pathology

How the malaria life cycle in

mosquitos determines where

malaria will be most prevalent


The mosquito has to survive long enough forIn the part of the life cycle carried out in mosquitos,

the oocyst to maturethe embedded ookinete becomes an oocyst which before it can infect anyone. So only elderly

grows rapidly and divides internally into mosquitoes can pass on malaria and in the

sporozoites - the third asexual phase. The oocyst is wild of course many mosquitoes never reach

old age.the longest phase in the life cycle lasting between

8 and 35 days. How long this phase takes is acutely This is where temperature matters, the

warmer the weather, the faster the oocystdependent on temperature.can develop in the mosquito. Mosquito

survival is probably the single most

important factor in malaria transmission.

Demonstrating the protective

effect of red cell mutations

against p. falciparum infection

The observed malaria protective effect of common erythrocyte variants.

In vitro In vivoCase-control

ReferencesInvasion/Growth

normal

inconclusive

Unknown Unknown Unknown

Protection: severe malaria(60-90%); mortality (55%)

Willcox et al. (1983a); Aidooet al. (2002); Ayi et al. (2004)

Friedman et al. (1979); Agarwalet al. (2000); Modiano et al. (2001)

Fairhurst et al. (2003); Mockenhaupt et al. (2004a)

Yuthavong et al. (1990); Hutagalung et al. (1999);Chotivanich et al. (2002)

Allen et al. (1997);Pattanapanyasat et al. (1999);Mockenhaupt et al. (2004b)

Willcox et al. (1983b);Ayi et al. (2004);

Gilles et al. (1967);Bienzle et al. (1972);Ruwende et al. (1995);Cappadoro et al. (1998)

Min-Oo et al. (2003);

Reduced risk: clinical malaria(29%); severe malaria (47-80%)

Reduced risk of clinical malaria(90%)

Reduced risk of severe malaria(risk = 0.4 - 0.66)

Protection against hospitaladmission with malaria (50%)

Protection of F(htz) againstnon-severe malaria;Protection of M and F(htz)against severe malaria (50%)

Reduced risk of complications(6.9x reduced odds)

N/A

N/A

No differencefrom controls

HbAS

HbAC

HbCC

HbAE

HbEE

α-Thalassaemia

β-Thalassaemia

G6PD deficiency

PK deficiency

Phagocytosis

growth under oxidativestress

Normal invasionmultiplication

invasion/multiplication

parasite invasion(25%)

multiplication; alteredknob formation

invasion/multiplication(low O2 conditions)

susceptibility tophagocytosis





susceptibility tophagocytosis(ring stage)

, decrease; , increase; M, male; F, female.

Figure by MIT OpenCourseWare. After Min-Oo and Gros, 2005.

High Frequency of Alpha Thalassemia Alleles in Regions of

the World with High Incidence of Falciparum Malaria

Image removed due to copyright restrictions. Map of global incidence of alpha-thalassemia alleles.

High Frequency of Beta Thalassemia Alleles in Regions of the

World with High Incidence of Falciparum Malaria

Image removed due to copyright restrictions. Map of global incidence of beta-thalassemia alleles.

Different !Thalassemia mutations are most

common in different populationsGeographic area Description

Mediterranean IVS-1, position 110 (G ! A)Codon 39, nonsense (CAG ! TAG)

IVS-1, position 1 (G ! A)

IVS-2, position 745 (C ! G)

IVS-1, position 6 (T ! C)

IVS-2, position 1 (G ! A)

African !2 9, (A ! G)!8 8, (C ! T)Poly(A), (AATAAA ! AACAAA)

Southeast Asian Codons 41/42, frameshift (!CTTT)IVS-2, position 654 (C ! T)

!2 8, (A ! G)Indian sub- IVS-1, position 5 (G ! C)

619-bp deletioncontinentCodons 8/9, frameshift (+G)

Codons 41/42, frameshift (!CTTT)

IVS-1, position 1 (G ! T)

Why do different human populations

have different allele frequencies for

many genetic loci?

• Genetic drift

• Founder effects

• Mutation

• Selection

Genetic Drift

• fluctuation in gene frequency due to

small size of breeding population

• fixation or extinction of allele possible

AAAaaa

AaAaAa

Aa

Aa

AAAA

AA

AA

aa

aa

aa

aa

AaAa

Aa

AAAaaa

AaAa

AaAa

Aa

AA

AA

AA

AA

aa

aa

aa aa

AaAaAa

aa

aa

aa

aa

aa

aa

AA AAAA

AA

AA

AA AA

AA

AA

AA

aa

aa

aa aa

Aa

aa

Aa

Aa

AaAa

AaAa

Aa

AaAa

Aa

Aa

AaAaAa

Aa

Aa

AaAa

Aa

Aa Aa

AaAa

AA AA

AA

AAAA

AA AA

AA

Genetic Drift

Founder Effect

• high frequency of gene in distinct population

• introduction at time when population is small

• continued relatively high frequency due to population

being “closed”

Aa

AAAAAA AA

AAAA

AA

AA

AAAA

AA

AA

AA

AA

AA

AA

AA

AA

AA

AA

AA

AAAA

AAAAAAAA

AAAA

AA

AAAA

Aa

AA

AA

AA

AA

AAAA

AAAA

AA

AA

AA

AAAa

Aa

Aa

Aa

AA

AA

AA

AA

AAAA

AAAA

AA

AA

AA

Aa

Aa

Aa

Aa

AA

AA

AA

AAAA

AAAA

AA

AA

AA

AAAa

Aa

Aa

Aa

aa

initial

population

"bottleneck" where

new population is

derived from small

sample

new population

with high

frequency of

mutant allele

Founder Effect

POSITIONAL CLONING

• RESOLUTION IN FAMILY ANALYSIS IS

LIMITED BY THE NUMBER OF FAMILY

MEMBERS YOU CAN COLLECT

• BUT IF THE AFFECTED INDIVIDUALS IN A

POPULATION CAN BE TREATED

ESSENTIALLY LIKE A LARGE FAMILY,

THEN INCREASED RESOLUTION CAN BE

ACHIEVED

What if you want better

resolution than the families

collected can give?

• Linkage disequilibrium can sometimesbe used to pinpoint position of diseasegene

• Linkage disequilibrium uses meiosesthat happened many generations in thepast to increase the resolution ofgenetic mapping

Linkage Disequilibrium Can Be Used to Identify the Position on a

Chromosome Most Likely to Contain the Disease Gene Because

of a Shared Chromosomal Haplotype Among Affected Individuals

A1 N

A2 N

A1 CF

Mutation

A2 N

A1 CF

A2 N

A1 CF

A2 N

A1 CF

A2 NA2 CF

A1 N

A1 CF

A2 N

Loci farapart

Loci closetogether

Frequentrecombination

Recombinationvery rare

Linkage disequilibrium

Linkage equilibrium

An explanation for linkage disequilibrium between a disease locus, such as cystic fibrosis, and a closelylinked marker locus. Frequencies of haplotypes reach equilibrium if the marker locus is far enough awayfrom the disease locus for many crossovers to have occurred during evolution, since the time of the originalmutation. For markers very closely linked to the disease locus, little recombination has occurred, and thusthe distribution of alleles observed in chromosomes with the CF mutation will be different from that observedin normal chromosomes.


HaplotypeAn associated set of alleles at two or more genetic loci on a chromosome which are

inherited together over multiple generations because the recombination rate betweenthem is very low relative to the number of generations considered

Linkage disequilibrium

If the alleles at a pair of loci are looked at jointly in a large number

of individuals, the presence of a particular allele at one locus may

be correlated with the presence of a particular allele at the other

locus; when this occurs the two loci are in linkage disequilibrium.

One major reason for two loci to show linkage disequilibrium is

that the two loci are very close together on a chromosome and the

mutation to give rise to one of the alleles has happened recently

enough that genetic recombination has not yet caused the new

mutant allele to be associated with the two alleles at the other

locus with equal frequency

i.e. they form a haplotype

The principle of positional cloning--affected individuals in a family share a

chromosomal segment which includes the mutation causing the disease--

Supposing many patients are actually related to each other even though we

do not know this for certain

Ancestor gets mutation

Descendants with disease allele carry region of identity to

ancestor and to each other

Linkage disequilibrium and haplotype analysis can be used to identify location

of disease gene if many individuals with disease are actually related to a

common ancestor

THE RELATIONSHIP BETWEEN DNA VARIANTS ON A

CHROMOSOME AND THE FUNCTIONAL “DISEASE ALLELE” ARE A

PRODUCT OF THE HISTORY OF MUTATIONS TO CREATE THE

CHROMSOMAL HAPLOTYPE

Emergence of Variations Over Variations in Chromosomes

Within a Population

Common

Ancestor

time present

Disease Mutation

Time

Linkage Disequilibrium

Between Marker KM 19 and

cystic fibrosisALLELE 1 ALLELE 2

CF 24 228CHROMOSOMES

NORMAL 284 66CHROMOSOMES

Linkage Disequilibrium

Between Marker XV2C and

cystic fibrosisALLELE 1 ALLELE 2

CF 235 109CHROMOSOMES

NORMAL 17 141CHROMOSOMES

Documents

HST.161 Molecular Biology and Genetics in Modern Medicine · Selection: Genetic Lethal Can Eliminate One Genetic Class at Some Point in Life AA Aa aa At conception p 2pq q 2 2 Early